Prof. Bosnic-Anticevich provides an overview of evidence that inhaler technique impacts on asthma disease outcomes. Her presentation includes an overview of technical determinants of inhaler technique, patient-related factors that matter and other considerations. She concludes with a discussion of what the future holds for inhaler devices in asthma.

Prof. Usherwood discusses treatment adherence and its relevance to asthma outcomes. Further, he discusses a range of approaches to assess and support optimal treatment adherence.

A high proportion of patients do not take their medications everyday as recommended

A high proportion of patients report that they perceive their inhaler technique to be good and find their inhalers easy to use (Jahedi et al. 2016 JAMPDD)

Patient motivation and beliefs (e.g. the necessity of medications) are important aspects predicting effective inhaler use, while concerns about medications and side effects are associated with lower use

Selection of the “ideal device” must be tailored to individual patient needs and should include consideration of factors from both the clinician and patient perspective

Other factors to consider in severe asthma include reduced lung function, device polypharmacy and experience with devices

Patients with reduced inspiratory flow are at increased risk of poor symptom control and asthma attacks, with decreased ability to use inhalers properly

Automated electronic inhaler monitoring devices that track usage and identify errors in technique can be used to provide patient feedback, improve technique and help identify patients with treatment-refractory asthma (Sulaiman et al, 2018, ERJ), and may be useful for future clinical management

Inhaler technique can be improved through education and training, but must be consistently revisited over time at every clinic visit

Treatment Adherence (Prof. Tim Usherwood):

In many cases, asthma may appear to be difficult-to-treat as a result of modifiable factors (including poor adherence and inhaler technique)

Treatment non-adherence may be intentional and result from either personal attributes and/or external constraints

Intentional non-adherence in severe asthma may relate to a range of factors including patient perception of treatment necessity, uncertainty of effectiveness, safety concerns, advice from family/friends, motivation, satisfaction in asthma management and perceived ease of use (Foster et al. 2011 IMJ)

To improve adherence, it is important to ask about medication use in an open and collaborative way at every consultation (e.g. normalise poor adherence, ask specifically about recent inhaler usage) and review patient / dispensing records to inform discussions, when available

Management of intentional non-adherence may include patient education, shared decision-making and motivational interviewing

Addressing non-intentional poor adherence may include modification of treatment complexity, a detailed written action plan, pharmacist support, reminders (e.g. text messaging) and a check of inhaler technique at every visit

About the Presenters:

Prof. Sinthia Bosnic-Anticevich is an internationally recognised respiratory researcher in the area of inhaler use and quality use of respiratory medicines. Trained as a pharmacist and basic scientist, Professor Bosnic-Anticevich spent several years in the pharmaceutical industry before returning to the University of Sydney developing and implementing the first problem-based learning course in a pharmacy curriculum in Australia.

Prof. Tim Usherwood is Professor of General Practice and Head of Westmead Clinical School, The University of Sydney. His research focusses on the development and evaluation of interventions to improve health outcomes in chronic disease.